ED, HF Docs Team Up to Cut Readmissions

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Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

A retrospective study showed that an early emergency department alert to a 24/7 dedicated heart failure team resulted in reduction of 30-day heart failure inpatient readmissions and increased utilization of a 24-hour observation unit.

ORLANDO -- An early alert system from the emergency department (ED) to a 24/7 dedicated heart failure team significantly cut down readmission rates, researchers found.

Thirty-day readmission rates decreased to a mean of 18.4% at 12 months following the implementation of the system, compared with 24.5% in the 12 months before implementation (P=0.003), according to Azam Hadi, MD, of the Indiana University School of Medicine in Indianapolis, and colleagues.

In addition, patients were more likely to be admitted for 24-hour observation under the alert system -- going from 19 pre-intervention to 34 patients post-intervention (P=0.03), Hadi reported here at the annual meeting of the Heart Failure Society of America.

Despite these strategies, the hospital was still plagued with significant readmission rates, senior author Irmina Gradus-Pizlo, MD, director of the advanced heart care program at Indiana University's Krannert Institute of Cardiology, told MedPage Today during an interview.

"We conducted an analysis that showed we had a lot of single-day admission stays, which indicated to us that some of those admissions were not necessary," Gradus-Pizlo said.

The alert is activated when the electronic medical record recognizes the registration of a heart failure patient in the ED within 30 days of being discharged.

The alert is distributed via page, email, and/or text message to an on-call heart failure team comprised of four physicians and four nurse practitioners, as well as the ED charge nurse and the heart failure team manager. Aggressive treatment is begun in the ED and continued when the heart failure team arrives.

"Prior to the system's implementation, almost all patients were admitted to the floor. The physicians in the [ED] just didn't have a good understanding of what they could do in the [ED] for these patients," Gradus-Pizlo said.

"Now that they've been working with the heart failure team, the [ED] physicians are more comfortable treating these patients aggressively and, importantly, more comfortable discharging them to observation when appropriate, such as when the patient's symptoms are due to a dietary indiscretion or a simple medication issue," she noted.

The early alert is aimed at assisting ED physicians to quickly triage patients and initiate aggressive treatment in the ED itself. If appropriate, patients are admitted to a dedicated 24-hour observation unit under the supervision of the heart failure team. The observation team enlists an aggressive multipronged approach including teaching/counseling, medication administration, and medication reconciliation.

Finally, the alert team helps to coordinate close clinic follow-up at the dedicated heart failure clinic.

For the study, researchers retrospectively compared 30-day readmission rates from January 2011 to January 2012 (pre-implementation) with those from the 12 months following implementation.

Although the total number of heart failure admissions did not differ in the two periods (833 versus 825), there were significantly fewer 30-day readmissions associated with the early alert system.

Gradus-Pizlo said the alert system should be reproducible in other large hospitals that have a dedicated heart failure team. In fact, four hospitals within the 18-hospital IU system are adopting the early alert program.

"The most important thing is to have physicians and nurses take ownership of the process," Gradus-Pizlo said.

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